MEDICARE: JON DAVID SORRELLS HIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	1305	LA

General Provider Information

NPI Number	:	1104464411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON DAVID SORRELLS HIS

Provider Business Mailing Address
First Line	:	555 DR MICHAEL DEBAKEY DR STE 104
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-5700
Country	:	US
Telephone Number	:	337-436-3277
Fax Number	:	337-439-3051

Provider Business Practice Location Address
First Line	:	2626 COUNTRY CLUB RD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5912
Country	:	US
Telephone Number	:	337-240-6600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2019
Last Update Date	:	11/27/2023

Similar Medicare Providers

1073554010 — DR. GINA LUISA GRECO-ANGELOPOULOS MD
Practice Location Address:

2640 COUNTRY CLUB RD , SUITE 400
LAKE CHARLES, LA
70605-5912

Practice Phone: 815-713-2600
Practice Fax:

1124115050 — ERIC A SANDERS DDS
Practice Location Address:

2620 COUNTRY CLUB RD
LAKE CHARLES, LA
70605-5912

Practice Phone: 337-433-5437
Practice Fax: 337-433-3271

1336208115 — DR. TROY MICHAEL LEFORT D.D.S.,
Practice Location Address:

2628 COUNTRY CLUB RD
LAKE CHARLES, LA
70605-5912

Practice Phone: 337-436-3631
Practice Fax: 337-436-3632

1386969558 — CASEY BRYANT BARGAS D.D.S
Practice Location Address:

2640 COUNTRY CLUB RD , 300
LAKE CHARLES, LA
70605-5912

Practice Phone: 337-564-6885
Practice Fax: 337-564-6907

1467715490 — CALCASIEU URGENT CARE LLC
Practice Location Address:

2640 COUNTRY CLUB RD , SUITE 400
LAKE CHARLES, LA
70605-5912

Practice Phone: 931-253-1110
Practice Fax:

1093116451 — DR. KALEB DESHOTEL D.C.
Practice Location Address:

2626 COUNTRY CLUB RD
LAKE CHARLES, LA
70605-5912

Practice Phone: 337-990-5497
Practice Fax: 337-990-5570

Directions to “ JON DAVID SORRELLS HIS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.